Healthcare Provider Details

I. General information

NPI: 1548862147
Provider Name (Legal Business Name): BEACH COTTAGE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10335 GULF BEACH HWY UNIT 1203
PENSACOLA FL
32507-2178
US

IV. Provider business mailing address

10335 GULF BEACH HWY UNIT 1203
PENSACOLA FL
32507-2178
US

V. Phone/Fax

Practice location:
  • Phone: 661-801-3113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH PAPA
Title or Position: OWNER
Credential: LMHC/LPC
Phone: 661-801-3113